| first authenticated cases of life-threatening envenoming by the hump-nosed pit viper (hypnale hypnale) in india. | in kerala, south-western india, five patients developed systemic envenoming after bites by hump-nosed pit vipers (hypnale hypnale), proved by identification of the snakes responsible. two of the dead snakes had been misidentified as saw-scaled vipers (echis carinatus), while three had remained unidentified. symptoms of local envenoming were pain, swelling, haemorrhagic blistering, bruising and regional lymphadenopathy. systemic symptoms included headache, nausea, vomiting and abdominal and chest ... | 2007 | 16839578 |
| snakes of medical importance in india: is the concept of the "big 4" still relevant and useful? | snakebites continue to be a major medical concern in india. however, there is very little hard evidence of a numerical nature to enable us to understand which species are responsible for mortality and morbidity. for many decades, the concept of the "big 4" snakes of medical importance has reflected the view that 4 species are responsible for indian snakebite mortality--the indian cobra (naja naja), the common krait (bungarus caeruleus), the russell's viper (daboia russelii) and the saw-scaled vi ... | 2007 | 17447706 |
| cross neutralization of hypnale hypnale (hump-nosed pit viper) venom by polyvalent and monovalent malayan pit viper antivenoms in vitro and in a rodent model. | hypnale hypnale (hump-nosed pit viper) is a medically important venomous snake in sri lanka and southwestern india. bite of this snake may result in hemostatic dysfunction, acute kidney injury and death. clinical studies indicated that the locally available polyvalent antivenoms produced in india are not effective against hump-nosed pit viper envenoming. hence, there is an urgent need to search for effective antivenom. in this paper, we examined the ability of calloselasma rhodostoma (malayan pi ... | 2010 | 21073851 |
| development of a new polyspecific antivenom for snakebite envenoming in sri lanka: analysis of its preclinical efficacy as compared to a currently available antivenom. | a new whole igg, freeze-dried, polyspecific antivenom was prepared from the plasma of horses immunized with the venoms of the snakes daboia russelii, echis carinatus, hypnale hypnale, and naja naja from sri lanka. the preclinical neutralizing ability of this antivenom against several toxic and enzymatic activities of these four venoms was analyzed, and compared with that of a batch of vins antivenom (india) being currently used in sri lanka. the activities tested were: lethality, hemorrhagic, in ... | 2016 | 27720977 |
| rare cardiac sequelae of a hump-nosed viper bite. | the hump-nosed pit viper (hypnale hypnale) is the commonest cause for venomous snakebites in sri lanka. previously, it was thought to cause only local envenomation. however recently, several systemic effects and even mortality has been reported. along with other snakes, such as the indian cobra (naja naja), the common krait (bungarus caeruleus), the russell's viper (daboia russelii) and the saw-scaled viper (echis carinatus), the hump-nosed viper is now also considered capable of causing lethal ... | 2015 | 26369415 |
| a study of snake bite among children presenting to a paediatric ward in the main teaching hospital of north central province of sri lanka. | snake bite is a common problem in the north central province of sri lanka. common krait (bungarus careuleus), ceylon krait (bungarus ceylonicus), cobra (naja naja), russell's viper (daboia russelii), saw-scaled viper (echis carinatus) and hump-nosed pit viper (hypnale hypnale) are the six species of venomous land snakes in sri lanka. a significant number of adults and children are bitten by snakes every year. however, the majority of research studies done in sri lanka and other countries show ad ... | 2014 | 25073710 |
| immunological properties of hypnale hypnale (hump-nosed pit viper) venom: antibody production with diagnostic and therapeutic potentials. | envenomation by hump-nosed pit viper (hypnale hypnale, hh) in sri lanka has caused significant morbidity and mortality, attributed to 35% of total venomous snakebites. in southwestern india (kerala), h. hypnale was increasingly identified as a dangerous and common source of envenomation, second to the russell's viper but ahead of the cobra bites. unfortunately, there is still no specific antivenom to date. this study aims to investigate the immunological properties of the venom and to assess the ... | 2012 | 22322247 |
| syndromic approach to treatment of snake bite in sri lanka based on results of a prospective national hospital-based survey of patients envenomed by identified snakes. | of 860 snakes brought to 10 hospitals in sri lanka with the patients they had bitten, 762 (89%) were venomous. russell's vipers (daboia russelii) and hump-nosed pit vipers (hypnale hypnale) were the most numerous and h. hypnale was the most widely distributed. fifty-one (6%) were misidentified by hospital staff, causing inappropriate antivenom treatment of 13 patients. distinctive clinical syndromes were identified to aid species diagnosis in most cases of snake bite in sri lanka where the bitin ... | 2009 | 19815895 |
| frequent and potentially fatal envenoming by hump-nosed pit vipers (hypnale hypnale and h. nepa) in sri lanka: lack of effective antivenom. | in a prospective study of snake bites involving 10 hospitals in sri lanka, 302 (35%) of 860 patients with bites by identified snakes proved to have been bitten by hump-nosed pit vipers (301 by hypnale hypnale and 1 by h. nepa). most victims were males aged between 11 years and 50 years who had been bitten on their feet or ankles while walking at night close to their homes. there was local swelling in 276 (91%) and local necrosis in 48 (16%). eleven (4%) required amputation of fingers or toes and ... | 2008 | 18455743 |
| haemostatic dysfunction and acute renal failure following envenoming by merrem's hump-nosed viper (hypnale hypnale) in sri lanka: first authenticated case. | a five years old boy was bitten by a merrem's hump-nosed viper (hypnale hypnale) in central province, sri lanka. he developed local swelling, incoagulable blood, thrombocytopenia, bleeding into the gastrointestinal tract, and acute renal failure. treatment with serum institute of indian polyspecific antivenom (specific for venoms of cobra, common krait, russell's viper and saw-scaled viper) had no effect on the coagulopathy, which persisted for more than a week. the boy recovered after 27 d in h ... | 2010 | 8036678 |
| microangiopathic hemolytic anemia following three different species of hump-nosed pit viper (genus: hypnale) envenoming in sri lanka. | there are 3 species of hump-nosed pit vipers in sri lanka: hypnale hypnale, hypnale zara, and hypnale nepa. the latter 2 are endemic to the country. microangiopathic hemolytic anemia (maha) is a known complication of hump-nosed pit viper bites. it was previously documented as a complication of general viper bites and not species specific. we report a series of 3 patients who developed maha after being bitten by each species of hump-nosed pit viper. the first patient was bitten by h hypnale and d ... | 2018 | 29361387 |
| prolonged coagulopathy, ecchymoses, and microangiopathic hemolytic anemia following hump-nosed pit viper (hypnale hypnale) bite in sri lanka. | a 74-year-old previously healthy woman was bitten by a hump-nosed pit viper (hypnale hypnale) at dusk causing incoagulable blood lasting for 6 days. further, she developed ecchymoses over her forearms, upper arms, hands, and lower back on day 4 after the snakebite, and microangiopathic hemolytic anemia (maha). features of this nature are rare after hump-nosed pit viper bite. | 2017 | 28755820 |
| transient distal renal tubular acidosis following hump nosed viper bite: two cases from sri lanka. | hump-nosed viper (hypnale hypnale; hnv) is one of the six major snake species in sri lanka that cause envenomation. nephrotoxicity, coagulopathy, and neurotoxicity are wellrecognized features of its envenomation. type 4 renal tubular acidosis (rta4) has only once been described previously in this condition, and we report two further cases. two patients aged 53 and 51 presented following hnv bites with acute kidney injury and microangiopathic hemolytic anemia. both underwent multiple cycles of he ... | 2017 | 27752013 |
| proteomic investigation of sri lankan hump-nosed pit viper (hypnale hypnale) venom. | the hump-nosed pit viper, hypanle hypnale, contributes to snakebite mortality and morbidity in sri lanka. studies showed that the venom is hemotoxic and nephrotoxic, with some biochemical and antigenic properties similar to the venom of calloselasma rhodostoma (malayan pit viper). to further characterize the complexity composition of the venom, we investigated the proteome of a pooled venom sample from >10 sri lankan h. hypnale with reverse-phase high performance liquid chromatography (rp-hplc), ... | 2015 | 25451538 |
| antivenom cross neutralisation in a suspected asian pit viper envenoming causing severe coagulopathy. | there is evidence of cross-neutralisation between common toxin groups in snake venoms and therefore the potential for antivenoms to be effective against species they are not raised against. here we present a 49 year old female bitten by an unknown pit-viper in nepal. she developed a venom induced consumption coagulopathy with an unrecordable international normalised ratio and undetectable fibrinogen. on return to australia 5 days post-bite she was treated successfully with one antivenom raised a ... | 2014 | 25178876 |
| presumptive thrombotic thrombocytopenic purpura following a hump-nosed viper (hypnale hypnale) bite: a case report. | hump-nosed viper bites are frequent in southern india and sri lanka. however, the published literature on this snakebite is limited and its venom composition is not well characterized. in this case, we report a patient with thrombotic thrombocytopenic purpura-like syndrome following envenoming which, to the best of our knowledge, has not been reported in the literature before. a 55-year-old woman from southern sri lanka presented to the local hospital 12 hours after a hump-nosed viper (hypnale h ... | 2014 | 24987409 |
| pharmacokinetics of the sri lankan hump-nosed pit viper (hypnale hypnale) venom following intravenous and intramuscular injections of the venom into rabbits. | the knowledge of venom pharmacokinetics is essential to improve the understanding of envenomation pathophysiology. using a double-sandwich elisa, this study investigated the pharmacokinetics of the venom of hump-nosed pit viper (hypnale hypnale) following intravenous and intramuscular injections into rabbits. the pharmacokinetics of the venom injected intravenously fitted a three-compartment model. there is a rapid (t1/2π = 0.4 h) and a slow (t1/2α = 0.8 h) distribution phase, followed by a long ... | 2014 | 24412778 |
| proteomic comparison of hypnale hypnale (hump-nosed pit-viper) and calloselasma rhodostoma (malayan pit-viper) venoms. | treatment of hypnale hypnale bites with commercial antivenoms, even those raised against its sister taxon calloselasma rhodostoma, has never been clinically successful. as these two genera have been separated for 20million years, we tested to see whether significant variations in venom had accumulated during this long period of evolutionary divergence, and thus could be responsible for the failure of antivenom. proteomic analyses of c. rhodostoma and h. hypnale venom were performed using 1d and ... | 2013 | 23911961 |
| hump-nosed pit viper (hypnale hypnale) envenoming causes mild coagulopathy with incomplete clotting factor consumption. | limited information exists on the coagulopathy caused by hump-nosed pit viper (hypnale hypnale) envenoming. | 2013 | 23879180 |
| epidemiology and clinical effects of hump-nosed pit viper (genus: hypnale) envenoming in sri lanka. | hump-nosed pit vipers of genus hypnale are the commonest cause of snake bite in sri lanka. although there are many reports of local effects, coagulopathy and acute kidney injury, it remains unclear how frequent these clinical effects are and therefore the medical importance of this snake genus. the genus has been recently revised to include hypnale hypnale from sri lanka and western ghats of southern india, and the two endemic species to sri lanka, hypnale zara and hypnale nepa. this was a prosp ... | 2013 | 23127899 |
| nephrotoxicity of hump-nosed pit viper (hypnale hypnale) venom in mice is preventable by the paraspecific hemato polyvalent antivenom (hpa). | mice experimentally envenomed with hypnale hypnale venom (1× and 1.5×ld₅₀) developed acute kidney injury (aki) principally characterized by raised blood urea and creatinine. prolonged blood clotting time and hemorrhage in lungs implied bleeding tendency. pallor noted in most renal cortices was suggestive of renal ischemia secondary to consumptive coagulopathy. intravenous infusion of hemato polyvalent antivenom following experimental envenoming effectively prevented death and aki in all mice, su ... | 2012 | 22975088 |
| coagulopthy, acute kidney injury and death following hypnale zara envenoming: the first case report from sri lanka. | snakebite is a major medical problem in developing asia. hump-nosed pit viper (genus hypnale) causes the most number of snakebites with significant morbidity and mortality in sri lanka. even though there are three species (hypnale hypnale, hypnale zara and hypnale nepa) in sri lanka there are few published literature on species-specific clinico-epidemiological data. this report describes an authenticated fatal case of a 47 years old male due to coagulopthy and acute kidney injury following enven ... | 2011 | 21967813 |
| excessive fibrinolysis: the coagulopathy following merrem's hump-nosed viper (hypnale hypnale) bites. | in 56 patients with proven hump-nosed viper (hypnale hypnale) bites, 12 (21.4%) developed continued oozing of blood from the site of the bite and a prolonged clotting time. further investigations showed low fibrinogen levels and increased fibrinogen degradation products in plamsa. the bleeding time, platelet count, prothrombin time, and partial thromboplastin time with kaolin were normal. the bite of this snake can be complicated with a coagulopathy in which excessive fibrinolysis seems to be th ... | 1998 | 9660472 |
| coagulopathy and fibrinolysis following the bite of a hump-nosed viper (hypnale hypnale). | | 2004 | 8758082 |
| efficacy of antivenom in the treatment of severe local envenomation by the hump-nosed viper (hypnale hypnale). | in sri lanka, the usual treatment for severe local envenomation by the hump-nosed viper (hypnale hypnale) is with polyspecific snake antivenom. we carried out a prospective, randomized, placebo-controlled, single-blind clinical trial to determine the efficacy and safety of polyspecific snake antivenom in the treatment of severe local envenomation by this snake. sixty-three patients with signs and symptoms of local envenomation by the hump-nosed viper lanka were randomized to receive either polys ... | 1995 | 7573709 |
| envenomation by the hump-nosed viper (hypnale hypnale). | we carried out a prospective clinical study from june to december 1993 at the base hospital in avissawella, sri lanka to determine the clinical features of envenomation by the hump-nosed viper (hypnale hypnale). sixty-two consecutive adult patients (63% males and 37% females, with a median age of 30 years [age range 13-68 years]) admitted to the medical unit following hump-nosed viper bites were surveyed. most (85.48%) of the patients were bitten on the feet, while 14.52% of the patients were bi ... | 1994 | 7810818 |
| proteomic analysis of human blister fluids following envenomation by three snake species in india: differential markers for venom mechanisms of action. | skin blistering as a result of snakebite envenomation is characteristic of some bites, however little is known regarding the mechanism of blister formation or the composition of the blister fluid. in order to investigate if blister fluid proteomes from humans suffering snakebite envenomation could provide insights on the pathophysiology of these skin alterations, blister fluid was collected from six patients upon presentation at a clinic in india bitten by three species of snakes, daboia russeli ... | 2019 | 31052189 |
| hump-nosed pit viper (hypnale hypnale and hypnale zara) envenoming in deniyaya, sri lanka: epidemiological and clinical features from a prospective observational study. | hypnale hypnale, hypnale zara and hypnale nepa are the three species of hump nosed pit vipers that are implicated in human bites in sri lanka. h. zara and h. nepa are two endemic species to the country. the objective of the study was to characterize epidemiology and clinical features after different hump nosed pit viper species bites. a prospective observational study was conducted in base hospital deniyaya from 2013 to 2015. hump nosed pit viper as the offending snake was identified when the vi ... | 2020 | 33144122 |
| thrombotic microangiopathy following hypnale zara (hump-nosed pit viper) envenoming: the first known case report from sri lanka. | a 65-y-old previously healthy farmer developed thrombotic microangiopathy (tma) comprising the triad of acute kidney injury, microangiopathic haemolysis, and thrombocytopenia after a proven hypnale zara (hump-nosed pit viper) bite. he developed coagulopathy, which was treated with fresh frozen plasma, and underwent 8 cycles of hemodialysis. he is being followed up in the nephrology clinic for acute kidney injury. tma caused by hypnale hypnale, the commonest species of genus hypnale, has previous ... | 2020 | 31870797 |
| enzyme immunoassays for detection and quantification of venoms of sri lankan snakes: application in the clinical setting. | detection and quantification of snake venom in envenomed patients' blood is important for identifying the species responsible for the bite, determining administration of antivenom, confirming whether sufficient antivenom has been given, detecting recurrence of envenoming, and in forensic investigation. currently, snake venom detection is not available in clinical practice in sri lanka. this study describes the development of enzyme immunoassays (eia) to differentiate and quantify venoms of russe ... | 2020 | 33017411 |
| clinical and epidemiologic profile and predictors of outcome of poisonous snake bites - an analysis of 1,500 cases from a tertiary care center in malabar, north kerala, india. | snake bites are a neglected public health problem in all tropical countries, and particularly in malabar region of kerala, india. demographic characteristics and clinical parameters vary in this part of the world, and studies based on them are scarce. increased incidence of capillary leak syndrome (cls) in hemotoxic snake bites and emergence of cases of hump-nosed pit viper (hnpv, hypnale hypnale) envenomation are some notable features seen here. | 2018 | 29892202 |
| basal but divergent: clinical implications of differential coagulotoxicity in a clade of asian vipers. | envenomations by asian pitvipers can induce multiple clinical complications resulting from coagulopathic and neuropathic effects. while intense research has been undertaken for some species, functional coagulopathic effects have been neglected. as these species' venoms affect the blood coagulation cascade we investigated their effects upon the human clotting cascade using venoms of species from the azemiops, calloselasma, deinagkistrodon and hypnale genera. calloselasma rhodostoma, deinagkistrod ... | 2019 | 30930232 |
| systemic bleeding including pulmonary haemorrhage following hump-nosed pit viper (hypnale hypnale) envenoming: a case report from sri lanka. | out of seven venomous land snake species of sri lanka, hump-nosed pit viper (hypnale spp.) causes the commonest venomous snakebites. it is widely distributed all over the country except in the peninsula of jaffna. the genus has three species naming h. hypnale, h. zara and h. nepa. they frequently cause local envenoming and rarely cause coagulopathy and acute kidney injury. systemic bleeding is the most trivial complication associated with coagulopathy caused by these snakes and pulmonary haemorr ... | 2019 | 31513811 |
| nephrotoxicity induced by the venom of hypnale hypnale from sri lanka: studies on isolated perfused rat kidney and renal tubular cell lines. | the hump-nosed pit viper hypnale hypnale is responsible for a high number of snakebite cases in southwestern india and sri lanka. although most patients only develop local signs and symptoms of envenoming, there is a growing body of evidence indicating that these envenomings may be associated with systemic alterations, including acute kidney injury. in this study we evaluated the renal toxicity of h. hypnale venom by using a perfused isolated rat kidney system and by assessing cytotoxicity in tw ... | 2019 | 31034846 |
| severe coagulopathy in merrem's hump-nosed pit viper (hypnale hypnale) envenoming unresponsive to fresh frozen plasma: a case report. | the merrem's hump-nosed viper (h. hypnale) causes many snakebites in south india and sri lanka. at present no antivenom is available for envenomings by this snake. a 42-year-old male bitten by a large h. hypnale, presented within 30 min of the bite and had a cardiac arrest soon after admission. this responded to standard advanced life support, but he had an unrecordably high international normalised ratio (inr), activated partial thromboplastin time and unrecordably low fibrinogen, consistent wi ... | 2019 | 30885617 |
| kidney injury following envenoming by hump-nosed pit viper (genus: hypnale) in sri lanka: proven and probable cases. | hump-nosed pit vipers (hypnale hypnale) are highly venomous snakes found in sri lanka and the western ghats region of india. they are the most common cause of venomous snakebites in sri lanka, mainly causing local envenoming leading to pain, swelling and necrosis. systemic envenoming causing acute kidney injury and coagulopathy are more commonly recognized following their bites. | 2019 | 30544230 |
| hyponatraemia and seizures in merrem's hump-nosed pit viper (hypnale hypnale) envenoming: a case report. | hump-nosed pit vipers (genus: hypnale) are medically important snakes in sri lanka and south india. merrem's hump-nosed pit viper (hypnale hypnale) frequently leads to potentially fatal envenomings in sri lanka and india. venom-induced consumption coagulopathay (vicc), local envenoming and acute kidney injury (aki) are the commonest effects of the envenoming by this snake. | 2018 | 30071895 |
| mass spectrometry-assisted venom profiling of hypnale hypnale found in the western ghats of india incorporating de novo sequencing approaches. | hypnale hypnale (hump-nosed pit viper) is considered to be one among the medically important venomous snake species of india and sri lanka. in the present study, venom proteome profiling of a single hypnale hypnale from western ghats of india was achieved using sds-page based protein separation followed by lc-ms/ms analysis. the identities of the proteins that were not established using the mascot search were determined through de novo sequencing tools such as novor followed by ms-blast based se ... | 2018 | 29990557 |
| cardiac arrest and atrial fibrillation in a patient after hump-nosed pit viper (hypnale hypnale) bite. | a 42-year-old previously healthy male patient died 16 days after a proven hump-nosed pit viper (hypnale hypnale) envenoming due to multi-organ failure. on admission he had cardiac arrest that recovered from cardiopulmonary resuscitation then developed atrial fibrillation which was reverted to normal rhythm by application of synchronized electrical cardioversion. he also had persistent coagulopathy and thrombotic microangiopathy comprising the triad of microangiopathic haemolysis, acute kidney in ... | 2018 | 29608921 |